Provider Demographics
NPI:1568954550
Name:DAVENPORT, KIMLEY LEA (PEER SUPPORTER)
Entity Type:Individual
Prefix:MS
First Name:KIMLEY
Middle Name:LEA
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:PEER SUPPORTER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44303-1438
Mailing Address - Country:US
Mailing Address - Phone:330-379-3467
Mailing Address - Fax:330-379-3465
Practice Address - Street 1:665 W MARKET ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44303-1438
Practice Address - Country:US
Practice Address - Phone:330-379-3467
Practice Address - Fax:330-379-3465
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-05
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist